Smokeless tobacco
Dipping tobacco (also known as American moist snuff or spit tobacco) is a form of smokeless tobacco. It is commonly referred to as dip while the act of using it as dipping, having a dip, or packing a dip. Chewing tobacco is often associated with this family of products. Usage Dip is sometimes "chew"; because of this, it is commonly confused with chewing tobacco. Instead of literally chewing on tobacco, a small clump of dip is 'pinched' out of the tin and placed between the lower or upper lip and gums. The dip rests on the inside lining of the mouth for approximately 20-30 minutes--ultimately the duration of a dip is determined by the user--where saliva carries nicotine to the inferior or superior labial arteries. Dip tobacco users often produce excess saliva while dipping. This is typically spat onto the ground or in a bottle because swallowing can cause irritation to the esophagus, nausea, and vomiting-- however, some (long-time) dippers can swallow the tobacco-caused saliva with no unusual effects . Smokeless tobacco is sometimes used in the workplace by employees, especially if the employer does not provide many cigarette breaks or if the employee is constantly using both hands during work (which doesn't provide opportunities for cigarette smoking). Dip is also used by many athletes and students to get nicotine without smoking. Cut sizes The difference between cut sizes are shown in the length of the individual strands of tobacco. Types Longer cuts are easier to manage than fine cuts (in regards to ease of grabbing the tobacco and keeping it comfortably in mouth). *Long Cut - Long cut comes in thin strands of tobacco around 7 mm long *Mid Cut - Mid-cut is comparable to small granules about 1 mm cubed. *Fine Cut - Fine cut comes in granules slightly larger than sand or coffee grounds. *Pouches - Pouches hold fine cut tobacco in a tiny, coffee filter-like pouch for simplicity. Health issues Cancer dangers Studies have shown that dipping tobacco has a relatively low risk for cancer, but some studies give conflicting results. One, done in 2004, shows that tobacco-specific nitrosamine (TSNA) levels were much higher in American dipping tobacco than those of Swedish products.Smokeless tobacco and oral cancer: a review of the risks and determinants. PubMed. Accessed on July 31, 2007. "Tobacco-specific nitrosamines (TSNAs) are believed to play a significant role as causes of cancer in people who use tobacco products."Tobacco-specific nitrosamines and their pyridine-N-glucuronides in the urine of smokers and smokeless tobacco users. PubMed. Accessed on July 31, 2007. The risk of mouth cancer is significantly debated by some American public health professionals, as noted in several recent and past studies.Researchers Find Snuff Dipping Increases the Risk of Oral Cancer New York Times. Accessed on July 31, 2007.Oral cancer in a tobacco-chewing US population—no apparent increased incidence or mortality. Accessed on July 31, 2007. However, most researchers emphasize that while smokeless tobacco may be a "less harmful" alternative to smoking, it is not a "safe" alternative to smoking.Public health implications of smokeless tobacco use as a harm reduction strategy. PubMed. Accessed on July 31, 2007. One recent study indicated that smokeless tobacco users are exposed to more NNK, a human carcinogen, than cigarette smokers. NNK is known to cause cancer in laboratory animals. This study, like others, stresses that smokeless tobacco use is not a "safe" alternative to cigarettes.Snuff Not Safe: Smokeless Tobacco Delivers More Of Some Dangerous Carcinogens Than Cigarettes. ScienceDaily. Accessed on August 11, 2007. "The three leading U.S. snuff brands (Copenhagen, Skoal fine cut, and Kodiak; making up 92% of the U.S. market (in 1994}) showed not only high levels of pH, nicotine, and unprotonated (free) nicotine, but also high concentrations of the strongly carcinogenic TSNAs in comparison with the fourth and fifth best selling moist snuff brands, Hawken and Skoal Bandits (3% of the U.S. market 1994)."Five leading U.S. commercial brands of moist snuff in 1994: assessment of carcinogenic N-nitrosamines. PubMed. Accessed on July 31, 2007. Cancer, however, is not frequently experienced as a consequence in Sweden, where smokeless tobacco use is well-established. It should be noted, however, that Swedish moist snuff ("Snus") utilizes a different manufacturing process that is speculated to reduce the amount of harmful chemicals delivered to the smokeless tobacco user, specifically by minimizing nitrosamine content.Effect of smokeless tobacco (snus) on smoking and public health in Sweden Cardiovascular effects Studies are inconclusive as to how significantly smokeless tobacco affects users' cardiovascular systems, but it has been studied that it may have more nicotine than cigarettes. One study states that, "Although the evidence is not conclusive, the adverse cardiovascular effects of smokeless tobacco use are less than those caused by smoking but are more than those found in nonusers."Smokeless tobacco and cardiovascular risk. PubMed. Accessed on June 1, 2007. Other studies also indicate that smokeless tobacco related cardiovascular risks are lower than that of smoked tobacco.Smokeless tobacco and cardiovascular disease. PubMed. Accessed on June 1, 2007.Overview of knowledge of health effects of smokeless tobacco. Increased risk of cardiovascular diseases and mortality because of snuff. PubMed. Accessed on June 1, 2007. One study states that smokeless tobacco use has a "modest effect on cardiovascular risk factors in young physically fit men."Smokeless tobacco, cardiovascular risk factors, and nicotine and cotinine levels in professional baseball players. PubMed. Accessed on June 1, 2007. However, it is important to note that one Indian study from the state of Rajasthan states, "There is a significantly greater prevalence of multiple cardiovascular risk factors sic obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking, as compared-to tobacco non-users. Chewing tobacco is associated with similar cardiovascular risk as smoking."Cardiovascular risk factors in tobacco-chewers: a controlled study. PubMed. Accessed on May 8, 2007. This finding may bear on the possibility that smokeless tobacco in India is produced differently than in Western countries. Due to contrasting results in studies, many conclude that further research should be done on the cardiovascular risks of smokeless tobacco.Epidemiology of cancer and other systemic effects associated with the use of smokeless tobacco. PubMed. Accessed on June 1, 2007.Is smokeless tobacco a risk factor for coronary heart disease? A systematic review of epidemiological studies. PubMed. Accessed on June 1, 2007. Misconceptions According to one study, only a "handful of websites" contain accurate information on the hazards of smokeless tobacco. 1/3 of websites relating to smokeless tobacco "explicitly" claim that smokeless tobacco is comparable to, or worse than, cigarettes. The conclusion reads: :"Through these websites, and presumably other information provided by the same government, advocacy, and educational organizations, ST tobacco users are told, in effect, that they might as well switch to smoking if they like it a bit more. Smokers and policy makers are told there is no potential for harm reduction. These messages are clearly false and likely harmful, representing violations of ethical standards."You might as well smoke; the misleading and harmful public message about smokeless tobacco. PubMed. Accessed on May 8, 2007. Addiction potential Smokeless tobacco contains nicotine, which is the primary addictive agent. According to European Union policy, Scandinavian or some American smokeless tobaccos are at least 90% less hazardous than cigarette smoking.European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health. Accessed on July 31, 2007. However, the habit is still addictive. Taxation and restriction of smoking is causing more smokeless tobacco use as "substitution." There are active public health debates regarding risk-reduction for smokers and the reconsideration of smokeless tobacco risks. "...There is a substantial body of informed and independent opinion that sees the value of harm reduction strategies based on smokeless tobacco."UK's Action on Smoking & Health (ASH..) Accessed on July 31, 2007. Additives There are few reports confirming exactly what additives are in smokeless tobacco, and it is very likely that brands vary in what and how much of each additive they use. It is widely claimed that glass or fiberglass is mixed into each tin to cause abrasion to the lip, resulting in higher and faster nicotine absorption. However, at least in the case of snus, the appearance of glass-like particles may be due to the formation of salt crystals.Frequently Asked Questions. Gothiatek. Accessed on November 25, 2007. The addition of glass to dipping tobacco would not be beneficial for increasing nicotine delivery, as bleeding and inflammation would be likely to reduce the uptake of nicotine.Smokeless tobacco and your health. Tobaccoharmreduction.org. Accessed on November 25, 2007. The amount of nicotine absorbed can be controlled by different cutting of the tobacco, increasing the nicotine concentration and raising the pH of the tobacco by adding various salts.Determination of nicotine, pH, and moisture content of six US commercial moist snuff products--Florida, January-February 1999. Journal of the American Medical Association, 1999 281, 2279-2280. Accessed on November 25, 2007. An alkaline pH causes more nicotine to be absorbed, especially the free, unprotonated form, but is irritating to the mucosa. Nicotine itself can also irritate the mucosa. Smokeless tobacco companies Connecticut-based UST Inc. held 62.5 percent of the market as of the third quarter of 2006, according to Morningstar. The company's brands include Copenhagen, Skoal, Husky, and Red Seal. The next two largest entities are the Conwood subsidiary of American Inc., and Swedish Match. In 2001, a type of dissolvable tobacco lozenge was developed by [http://www.starscientific.com Star Scientific, sold and marketed under the brand names Ariva and Stonewall. The company claims that the product is "spit-less", and that its manufacturing process possibly reduces TSNA levels. In 2006, "spit-less" snus tobacco products were test-marketed by Altria Group Inc. (formerly Phillip Morris Companies) and R.J. Reynolds Tobacco Company, under the names Taboka and Camel SnusABC News: Smokeless Tobacco: No Chewing, No Spitting, and Fewer Cancer-Causing Chemicals? Accessed on July 31, 2007.. Canadian tins are smaller in size compared to tins produced for the United States. US tins are generally 34 gramsTins of Skoal Long Cut and Copenhagen Long Cut each are labelled "NT WT. 1.2 OZ. (34.02 g)." while Canadian tins are 15 grams. Smokeless tobacco products are also more expensive in Canada compared to the United States. Prices for a 15 gram tin of average, popular brand smokeless tobacco are normally around $6-7, in Canadian funds. Though prices tend to vary more from one state to the next in the US, it is quite common to find the same brands of smokeless tobacco products in containers twice the size as Canadian ones, for around half the price with currency differences taken into account. Canadian users wait longer for new products to be released and spend, depending on province, up to 40% more.Smokeless tobacco in Canada: deterring market development Many flavours are not released in Canadian markets until much later due to tobacco denormalization laws.A National Strategy ISBN 0-662-64463-8 Appendix C Legality Given the risk of mouth cancer and a fairly low usage outside of North America and the Nordic countries, several countries have banned the sale (and in some cases the import) of dipping tobacco. Sale of dipping tobacco was banned in Australia and New Zealand in 1986 eMJA: Availability of smokeless tobacco products in south Asian grocery shops in Sydney, 2004 and in most of the EU nations in 1992 British American Tobacco - EU Social Reporting - Issues. Both Sweden and Norway were exempted from this ban because of the traditionally high usage of dipping tobacco in both countries. See also * CNS stimulating drugs * Nicotine withdrawal * Tobacco smoking References External links *Smokeout: Not as easy as ABC - Commentary - The Washington Times, America's Newspaper *Effect of smokeless tobacco (snus) on smoking and public health in Sweden *No Smoke, No Problem? *Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. By Brad Rodu and William T. Godshall, published in December 2006 in Harm Reduction Journal. Category:CNS stimulating drugs Category:Tobacco